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A large number of reports have been devoted to the physiologic and toxic effects of methyl chloride, many of which are based on case histories involving occupational exposure. The detrimental actions of methyl chloride on the central and peripheral nervous systems are well established effects. It is a moderately severe narcotic and potentially severe nerve poison. Chronic intoxication is associated with damage to the central nervous system (CNS), kidneys, liver, bone marrow, cardiovascular system, respiratory system, and intestinal tract. The signs and symptoms range from the more severe medical dysfunctions such as cardiac irregularities, respiratory paralysis, nerve degeneration, and severe convulsions to the more subtle clinical observations such as CNS depression, nervousness and emotional instability, insomnia and anorexia, ataxia, blurred vision, light-headedness, nausea, dizziness, narcosis, and disorientation. The behavioral correlates of these and other neurotoxic effects of methyl chloride suggest that a gradual behavioral degradation occurs. Pharmacodynamic studies have shown the compound to be rapidly absorbed by the blood with most authors attributing the toxicity to an enzyme-catalyzed methylation reaction in the body. Despite the fact that several investigators have attempted to correlate such biological responses of methyl chloride with its toxicity, the present knowledge of the problem still lacks a detailed mechanism of action. Until such mechanisms are verified, adequate methods to assess subclinical neurological and behavioral changes must be effectively developed.
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PMID:Behavioral, neurological, and toxic effects of methyl chloride: a review of the literature. 38 67

A menstrual symptom questionnaire was used to assess the incidence of premenstrual tension (PMT) in 1,395 regularly menstruating women not on hormonal contraceptives or any other hormonal therapy during routine visits to a gynecologic clinic. Nineteen symptoms were divided into four PMT subgroups: PMT-A (anxiety, irritability, mood swings, nervous tension), PMT-H (weight gain, swelling of extremities, breast tenderness, abdominal bloating), PMT-C (headache, craving for sweets, increased appetite, heart pounding, fatigue and dizziness or fainting) and PMT-D (depression, forgetfulness, crying, confusion, insomnia). The ages of the patients ranged from 13 to 54 years, with a mean +/- S.D. of 32 +/- 8.5 years. Using strict criteria for PMT, 702 patients scored positive for at least one subgroup of PMT, giving an incidence of 50%. When the patients were divided into five-year age groups, a peak incidence of 60% was observed in the third decade of life. The most common PMT subgroups were PMT-A and PMT-H, occurring either alone or in combination. The least common subgroup was PMT-D, occurring in only 12 patients and by itself. The mean cycle length in pure PMT-D patients was significantly shorter (p less than 0.05) than in patients without PMT.
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PMID:The incidence of premenstrual tension in a gynecologic clinic. 689 20

A 39-year old woman presented with hallucinatory paranoid state, particularly with erotomania, around September, 1988 (at the age of 39), and was hospitalized in a mental hospital for 9 days from May 1, 1989, to receive major tranquilizer therapy. At admission, the leukocyte count was 10,400/mm3 showing a mild leukocytosis, and there was temporary adynamia in the upper extremities. Thereafter, mild leukocytosis persisted intermittently. On May 12, 1989, the patient visited the Department of Neuropsychiatry, Kansai Medical University, and clinical examinations revealed mental symptoms including insomnia and erotomania, delusion of reference and auditory hallucination without persecutory taint. She showed clear consciousness and well understanding. Characteristically, her expression and behavior were smooth and emotional communication was available. There were neither alterations in her basic mood, nor flaccid association of idea. No abnormalities were seen in the hair and skin, and buffalo hump was not observed. Blood examination revealed a leukocyte count of 10,700/mm3, suggesting a mild leukocytosis. According to the patient, the menses have been regular. Although major tranquilizer therapy has been maintained, she gradually developed emotional instability, and tended to show fatigue and regressive changes in her personality. She was hospitalized in a mental hospital from October 25, 1989 to July 24, 1991. Since 1990, when she was in the hospital, she gradually developed obesity, hypertension, acne, and diabetes mellitus.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A case of Cushing's disease: hallucinatory paranoid state preceding physical symptoms]. 793 10

A mixed affective syndrome is described which meets the criteria for major depression but not those of the DSM III-R for a mixed state. The clinical picture is characterized by lack of motor retardation and fluent verbalization; the facial expression is animated and sometimes dramatic. Patients suffer considerably and are often tearful. They complain of inner tension and restlessness, racing thoughts and despair. Emotional lability and momentary irritability are observed. Insomnia occurs initially or with frequent early waking. Suicidal ideation occurs and makes the syndrome of concern in view of its impulsive nature. Antidepressants increase restlessness, insomnia, aggressiveness and the impulsiveness of suicidal ideation. Low-dose neuroleptics, lithium and anticonvulsivants are highly effective. A few sessions of ECT offer rapid improvement.
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PMID:[Anxious-excited depression: a mixed affective syndrome]. 858 15

The history of eponyms for epilepsy in the lands of the Eastern globe present the portrait of the attitudes of both the laymen and skilled people towards the disease and patient, as well as to the Nature itself. As opposed to the West which during the Middle ages changed its concepts of epilepsy as the organic brain disease for the sublime 'alchemic' position, the people of the East were more prone to consider from the beginning of their civilization till the XIX century that epilepsy is the consequence of the evanescent spiritual and extracorporal forces which by themselves were out of their reach. As compared to the western civilization, the historical resources are, often as a consequence of a linguistic barriers, more scarce-as consequently is the number of eponyms, but are nevertheless picturesque. The medical science from Babylonian period presumed that epileptic manifestations are the consequence of the demonic or ill spiritual actions. There existed an attitude that at the beginning of an epileptic attack the patient was possessed by a demon (the Akkadic, i.e., Babylonian verb "sibtu" denoting epilepsy, had the meaning "to seize" or "to be obsessed"); at the end of the clonic phase the demon departed from the body. Different demons were responsible for different forms of epilepsy such as nocturnal and children epilepsy, absence epilepsy and pure convulsions, simple and complex automatisms, and gelastic epilepsy. Thus, the doctors from the period of Babylon aside from making primordial classification of epilepsies, knew about their clinical picture (prodromal symptoms and aura, Jackson's epilepsy. Todd's paralysis), postictal phenomena and intericatl emotional instability; provocative factors were also known (sleep deprivation, emotions, as well as alcohol, albeit in a negative sense-as a cure for epilepsy). There is no doubt than in the period of Babylon the clinical picture of serial fits and its progress to status epilepticus were clearly recognized and considered as life threatening events. Persian history of epilepsy, except from the 6th century Zoroastrian "Avesta" document, lacks the written or spoken medical heritage untill the 7th century A.D. and the Arabic conquest of the entire Moslem world. On the other hand, Islamic medicine should be freed from the simple prejudice that the Moslem authors were only the translators of Greek medicine; contrary to such a view, their work contains a high degree of individuality. Although Mohammed introduced a lot of novelty into medicine, Khoran and the Sayings do not explicitly refer to epilepsy. Of importance is to notice that Moslem medicine did not have demons in the "repertoire" of direct causes of epilepsy. The causes and the cures of epilepsy were more magic-mystical and occult in nature, which is reminiscent of the European, as well as Serbian Middle age attitudes. Avicenna recognized difference between children and adult epilepsy. He considered insomnia and afternoon siesta as well as intensive sounds and light to be a provocative factors, whereby we see that at least empirically he knew of sleep (deprivation), startle and reflex epilepsy. The XIII century invasion of Mongols brought about the recession in Moslem Medicine; it recovered only in the XVIII century under the strong influence of European medicine handed over to us through Jewish doctors of various nationalities. The story of the China history of epilepsy has its debut approximately in the 8th century B. C. Medical texts from this period name epilepsy "Dian" and "Xian" which meant "the falling sickness" and "convulsions", respectively. Chinese medical terminology often interchangeably used the words "mania", "madness" and "psychosis" for "epilepsy" which, aside from a prominent language barrier, brings additional confusion. Although Chinese documents gave the first description of the grand mal epileptic attack already in the 8th century B. C. (ABSTRACT TRUNCATED)
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PMID:[Eponyms and epilepsy (history of Eastern civilizations)]. 910 52

Postpartum depression often occurs with symptoms of dysphoria, emotional instability, anxiety, insomnia, headache, loss of appetite reaching its peak 3-6 days after childbirth, with an incidence of 26-85% of women giving birth being affected. Postpartum contraception requires medical consultation during the puerperal period when the time of return of ovulation is also discussed. Oral contraceptives pose some risk of thromboembolism, especially in the first 10 days postpartum and also have an effect on lactation, but help faster return of menstruation and the diminution of menstrual flow. OCs should be prescribed 10-15 days postpartum. For women who nurse OCs containing progestational hormones could be prescribed which have a 99% effectiveness in the first year of use. Injectables also containing progestational hormones are commenced 7 days postpartum and are effective for 8-12 weeks. Implants are implanted 4 weeks postpartum and are effective for 5 years. The IUD could be inserted after the return of menstruation to avoid any risk of uterine perforation. Tubal ligation is usually performed 24-48 postpartum by periumbilical minilaparotomy. Natural methods are not recommended because of their low efficacy and difficulty of interpretation during this period, while barrier methods (both the male and female condom) using spermicides are more effective.
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PMID:[Postpartum contraception]. 1217 61

The etiology of psychotic symptoms that emerge following surgery needs to be sought to allow physicians to provide effective treatment. We present the case of a patient who developed hyperthyroidism shortly after excision of a mandible bone tumor and discuss its clinical features, course, and management. A 48-year-old female without previous thyroid disease accidentally found a tumor over her left mandible bone and underwent excision of the tumor. Soon after surgery, she suffered from anxiety, mood swings, insomnia, and even auditory hallucinations. Through careful differential diagnosis and a series of examinations, she was shown to be in a hyperthyroid state. Her condition improved after short-term use of haloperidol, lithium, and methimazole. Her thyroid function recovered and she was free from any psychiatric symptoms during the 1-year follow-up. Hyperthyroidism following surgery is not uncommon and its possibility should be considered when making differential diagnoses.
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PMID:Acute psychotic state due to hyperthyroidism following excision of a mandible bone tumor: a case report. 1269 23

In studies made in the last decade, patients consulting doctors because of depression and anxiety have very often turned out to suffer from bipolar type II and similar conditions with alternating depression and hypomania/mania (the bipolar spectrum disorders - BP). Specifically, about every second patient seeking consultation because of depression has been shown to suffer from BP, mainly bipolar type II. BP is often concealed by other psychiatric conditions, e.g. recurrent depression, psychosis, anxiety, addiction, personality disorder, attention-deficit hyperactivity disorder and eating disorder. BP shows strong heredity. Relatives of patients with BP also have a high frequency of the psychiatric conditions just mentioned. Conversion ("switching") from recurrent unipolar depressions (recurrent UP) to BP is common in very long longitudinal studies (over decades). Mood-stabilizing medicines are recommended to a great extent in the treatment of BP, since anti-depressive medicines are often not effective and involve a substantial risk of inducing mood swings. Particularly in the long-term pharmacological treatment of depression in BP anti-depressive medicines may worsen the condition, e.g. inducing a symptom triad of dysphoria, irritability and insomnia: ACID (antidepressant-associated chronic irritable dysphoria).
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PMID:Bipolar II and the bipolar spectrum. 1650 Jul 95

The objective of this study was to assess the efficacy and safety of standardized extract SHR-5 of rhizomes of Rhodiola rosea L. in patients suffering from a current episode of mild/moderate depression. The phase III clinical trial was carried out as a randomized double-blind placebo-controlled study with parallel groups over 6 weeks. Participants, males and females aged 18-70 years, were selected according to DSM-IV diagnostic criteria for depression, the severity of which was determined by scores gained in Beck Depression Inventory and Hamilton Rating Scale for Depression (HAMD) questionnaires. Patients with initial HAMD scores between 21 and 31 were randomized into three groups, one of which (group A: 31 patients) received two tablets daily of SHR-5 (340 mg/day), a second (group B: 29 patients) received two tablets twice per day of SHR-5 (680 mg/day), and a third (group C: 29 patients) received two placebo tablets daily. The efficacy of SHR-5 extract with respect to depressive complaints was assessed on days 0 and 42 of the study period from total and specific subgroup HAMD scores. For individuals in groups A and B, overall depression, together with insomnia, emotional instability and somatization, but not self-esteem, improved significantly following medication, whilst the placebo group did not show such improvements. No serious side-effects were reported in any of the groups A-C. It is concluded that the standardized extract SHR-5 shows anti-depressive potency in patients with mild to moderate depression when administered in dosages of either 340 or 680 mg/day over a 6-week period.
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PMID:Clinical trial of Rhodiola rosea L. extract SHR-5 in the treatment of mild to moderate depression. 1799 Jan 95

The function and dysfunction of the central noradrenergic system were reviewed together with the implications for the pathophysiological understanding of functional psychosis. Like the peripheral noradrenergic system, the central noradrenergic system plays a pivotal role in fight/flight reactions and stress. Overactivity of the system induces not only a sympathotonic state but also hyperarousal accompanied by insomnia, anxiety, irritability, emotional instability, paranoia, and excitation. On the other hand, its underactivity lowers the sympathetic tone and arousal level, resulting in hypersomnia, blunted responsiveness, or apathy. It has been confirmed in animal experiments that excess stress causes dysfunctions of the central noradrenergic system as a result of compensation, such as the overutilization-induced oversynthesis of noradrenaline. Dysfunction of the system, particularly its overactivity, plays an important role in various functional psychoses such as anxiety disorder, schizophrenia, and mood disorder, as well as behavioral and psychological symptoms of dementia (BPSD). Pharmacologically, the sedative effect of minor and major tranquilizers on hyperarousal is mediated by their action as noradrenaline antagonists. Some antidepressants potentiate noradrenergic activity, and should be used carefully in hyperaroused depressive patients. Thus, clinical evaluation of the central noradrenergic pathophysiology will provide us with information related to arousal to advance our understanding and treatment of functional psychoses.
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PMID:[Central noradrenergic system in psychiatry]. 1982 61


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